Special situations
Drugs are often used in the perpetration of crimes; in particular
drug-assisted sexual assault.
Common drugs used include a benzodiazepine, like Rohypnol
(Roofies), and Gamma Hydroxy Butyrate (GHB). These drugs
cause retrograde amnesia, leaving the victims with no memory
of the event.
These victims may never have been exposed to these drugs;
they have never used or taken drugs before. This would make it
the first time the person has been exposed to this drug. Being
a single dose it is eliminated quickly, within hours, making the
window for detecting them in the system very short. By the
time the victim realises that something has happened, days
may have passed and no drugs would be found in blood or
urine.
Nyaope (whoonga, wunga) is a street name for local street
drugs; the content will vary between different areas and
between different suppliers. It is a mixture of drugs and may
contain varying amounts of cannabis, methamphetamines
and/or heroin, as well as any other bulking agents such as
baking powder, rat poison or icing sugar. There are claims that
it may contain anti-retrovirals as well.
Bath Salts is an American term used for designer drugs, it
contains synthetic forms of the naturally-occuring cathinones
found in the khat plant (Catha edulis), for example
methcathinone (Kat or Cat). The manufacture of this drug is
possibly slightly more sophisticated than Nyaope, but can also
contain mixtures of drugs and different drugs according to the
supplier.
These drugs don't come with a package insert with related
information, warnings or side effects. They have no
manufacturing standards. The users literally take their lives in
their hands when using these drugs.
A cup test does not test for Kat or mandrax, unless stated on
the cup. It tests for specific compounds at specific cut-offs,
giving a positive/negative result. If you want to test for Kat
(methcathinone, a synthetic amphetamine) you have to be
certain that the cup test can measure it. The test may pick up
on the ephedrine that is used to manufacture Kat, but not the
Kat itself.
Design done and printed by
Conclusion
When subjecting someone to a drug test, there has to be a
clear indication in mind. If not, the result will not give the
required information, leading to disappointment and frustration.
There is no quick test that detects all possible drugs, especially
if the person took the drugs a few days ago. A negative test
does not say that the person does not use drugs. A negative
test result may mean that there just wasn't enough of the drug
to give a positive result. A positive test requires the person to
have taken the drug that is being tested for, in a sufficient
quantity to give a positive result well within the detection
window (before the drug is eliminated completely from the
body).
The quick, easy and inexpensive tests are usually screening
tests for specific drugs. They turn positive when a certain
minimum amount of drug is present. The more sensitive tests,
which can measure more drugs, and at lower concentrations
require more specialised equipment, take longer to perform
and are more expensive.
You should know why you are doing the test, what drug you
are testing for, and if you want a positive/negative result only or
a specific drug concentration.
The testing of powders and tablets are generally not performed
by routine laboratories, but by forensic laboratories either in the
State or by University laboratories.
If there is any doubt seek the advice of a qualified health
professional.
HEAD OFFICE
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Richmond, Johannesburg, South Africa
(011) 358 0800
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PRETORIA MAIN LABORATORY
1st Floor Pencardia Building, 509 Pretorius Street, Arcadia,
South Africa. (012) 483 0100 Guide to Drug Testing
DURBAN MAIN LABORATORY
102 Lancet Medical Centre, 74 Ismail C Meer Street, Durban,
South Africa. (031) 308 6500
www.lancet.co.za @LancetLab
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Guide to Drug testing
This guide serves to inform you of the different types of drug tests
available, what type of test to choose, and under which circumstances.
Drugs can be divided into legally prescribed drugs like benzodiazepines
(e.g. Valium), opiates and other analgesics, and illicit drugs like
amphetamines, cocaine and marijuana. Prescription drugs are often
abused and can also be obtained illicitly. Individuals who are abusing drugs
display clinical signs that are associated with the drug of abuse.
Laboratory Testing
The laboratory is asked to test patient samples for drugs when drug abuse
is suspected. There are 2 general test categories available: screening tests
and confirmation tests. The screening test is to separate patients that are
negative from those that are not. The samples that test not negative (i.e.
positive) with the screening test, should be subjected to a confirmation
test. The confirmation test will identify the specific drug present, or if the
confirmation test is negative classify the screening test result as a false-
positive screening test.
Screening Test
The most commonly used type of test in this group is called an
immunoassay. It can take the form of a near patient test or a test
performed on a large automated instrument in a laboratory.
Near Patient Testing
Typically a testing strip is used, or a cup/device where the test strip forms
part of the device. These devices can be quite sophisticated and can even
test the temperature of the urine sample, as well as for the presence of
adulterants. An adulterant is something the donor uses, either by adding it
to the urine or consuming it themselves, to alter the outcome of the test.
Testing the temperature of the urine sample and for the presence of
adulterants is done to ensure that the sample has not been tampered with.
These devices can also test for a number of drugs at the same time. The
result is given as either positive (sometimes also called non-negative) or
negative.
These tests are often used in workplace drug testing, where the
requirement is that the test only turns positive once a minimum amount of
drug has been detected, in other words at a given cut-off. These devices
are quick, inexpensive and once a non-negative result has been obtained,
that same sample can be sealed and sent to the laboratory for confirmation
testing.
Laboratory Testing
Immunoassays are also available as a test performed by large automated
analysers in the laboratory. The sample is placed in a tube/container and
sent to the laboratory for testing.
These tests are done for specific drug classes; these have to be specified
on the request form. If more than 1 drug class is needed, for example
cannabis and opiates, it has to be specified. This type of testing is quick;
the tests pick up the drugs easily and are easy to perform. The result is
reported as negative below a certain cut-off. This cut-off is often
determined by the manufacturer, or a legal cut-off can be used. Above the
cut-off the result is reported as a numerical value. In urine samples,
although the concentration of the drug is obtained, the result gives no
indication of the physical state of the urine sample donor at the time of
collection.
As with near patient testing, laboratory testing is also inexpensive, Blood is the sample of choice if you want to measure the drug
however there are limitations to both types of screening tests. The concentration present at the time of taking the sample. It is used to
limitations of all immunoassays, near patient and laboratory monitor therapeutic drugs, like the anti-convulsants. Because of the
automated, include: only drug classes are tested for (e.g. opiates), irregular use of illicit drugs and the fact that they get eliminated from
NOT the specific drug (e.g. codeine vs. morphine the one a the blood relatively quickly, it is not the sample of choice to test for
common pain killer, the other a highly controlled drug used for suspected illicit drug abuse.
specific reasons).
These tests are also prone to cross-reactions, as seen with codeine Hair is a very attractive sample type. It is easy to obtain and it can't
and morphine (both give positive opiate screening results). Another be tampered with. Hair also gives a longer timeline to assess drug
example is Valium and Dormicum, both are benzodiazepines, but exposure. There are however problems with using hair for drug
they don't give the same screening result. Valium will give a higher testing; it requires specialised instruments and personnel to analyse
result than a similar amount of Dormicum. Stocrin, an anti-retroviral it. It is uncertain if it is admissible in court as evidence. Testing
agent, can give a false-positive cannabis result with certain test laboratories that can process hair samples are not readily available.
systems.
Antibodies present in the sample may also react with the testing Saliva is another attractive sample type, as it is not invasive to take
system, giving false-positive as well as false-negative results. the sample and drug levels are comparable to blood levels. As with
hair samples, it may also not be admissible in court and requires
Confirmation Test specialised instruments to measure it. Testing laboratories that can
process saliva samples are not readily available.
This category of testing is performed once a non-negative (i.e.
positive) result has been obtained on a screening test. It is Sweat testing is being used to assess long term abstinence from
performed in the laboratory, on highly specialised instruments. It is drugs. Once again, testing laboratories that can process sweat
more expensive than a screening test, and it takes longer to obtain a samples are also not readily available.
result. The results are given as an amount, or concentration of drug
in the sample. In urine samples this concentration does not provide How long are drugs detectable in your system?
information about how much of the drug was taken, when the drug
was taken, or how affected the person was at the time of giving the The time period drugs are detectable is affected by the amount of
urine sample. These tests can distinguish between different drugs drug used, the use of other concomitant drugs, how often the drug
within a drug class. For example: if a positive opiate result was is used, and the metabolism of the individual.
obtained on a screening test, the specific opiate will be identified
with the confirmation test, either codeine, morphine or heroin. Average times of drug detection are listed in the table below.
Why do drug testing?
Window of
The reason can be medical or legal. Medical testing is done when a Drug Street Name
detection
person is taken to a medical facility because of acute illness, and on
2-3 days
examination, is suspected to be under the influence of a drug. Cocaine Coke, Crack, Snow max 22 days
Testing can help to make a diagnosis and guide the immediate
treatment. Crank, Crystal Meth, 60 hours
Methamphetamines max 6 days
In a more chronic setting, if a person's behaviour has changed and Speed, Ice, Tik
drug abuse is considered as a cause of the behavioural change, Grass, Herb, Pot,
1-4 days (occasional)
testing is also performed. Drug testing can also be done in known Cannabis 12 days (moderate)
Weed 22 days (chronic use)
drug abusers to ensure they are not using drugs. These tests are
done without legal implications; the result does not have to stand up 1-3 days
Amphetamine Crosses, Hearts max 9 days
in a court of law. In legal cases, testing is done after an accident or
a crime. It can also be part of a workplace drug screening Dover s Powder, 10 hours - 6 days
programme. In these situations the legal validity of the sample Opiates Paregoric max 10 days
becomes paramount. This does not form part of this discussion. Oxycodone
(naloxone, hydrocodone, Oxy 1-2 days
hydromorphone, oxymorphone)
Which sample: Urine, Blood or Hair?
Darvon, Pinks, 6 hours
Propoxyphene 2 days
Sample type depends on the type of testing that is required; urine is Footballs
the sample of choice for the average clinical testing. 3-7 days
A urine sample is non-invasive, easy to obtain, its collection requires Benzodiazepines Tranks, Xanax
4-6 weeks (chronic)
no specialised training, and it is an easy sample to analyse.
2 days (short acting)
The way in which drugs are eliminated from the body also means it Barbiturates Barbs
is possible to detect these agents for a longer period of time in a 2-3 weeks (long acting)
urine sample. However, these samples can be tampered with and E, XTC, Love drug,
Ecstasy (MDMA) 1-3 days
this is why most laboratories do some tests to exclude tampering or Hug drug, Lover s Speed
adulteration.